|
POLYSACCHARIDE IRON COMPLEX 150 MG IRON CAPSULE
|
Facility
|
OP
|
$418.30
|
|
|
Service Code
|
NDC 51991020311
|
| Hospital Charge Code |
11050
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$154.77 |
| Max. Negotiated Rate |
$376.47 |
| Rate for Payer: Aetna American Axle |
$271.90
|
| Rate for Payer: Aetna Commercial |
$355.56
|
| Rate for Payer: Aetna Medicare |
$209.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$271.90
|
| Rate for Payer: BCBS Complete |
$167.32
|
| Rate for Payer: Cash Price |
$334.64
|
| Rate for Payer: Cofinity Commercial |
$292.81
|
| Rate for Payer: Cofinity Commercial |
$359.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$292.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$334.64
|
| Rate for Payer: Healthscope Commercial |
$376.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$292.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$313.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$355.56
|
| Rate for Payer: PHP Commercial |
$355.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$271.90
|
| Rate for Payer: Priority Health SBD |
$263.53
|
| Rate for Payer: UMR Bronson Commercial |
$154.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$313.72
|
|
|
POLYSACCHARIDE IRON COMPLEX 150 MG IRON CAPSULE
|
Facility
|
IP
|
$230.30
|
|
|
Service Code
|
NDC 00904539561
|
| Hospital Charge Code |
11050
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.33 |
| Max. Negotiated Rate |
$207.27 |
| Rate for Payer: Aetna American Axle |
$149.70
|
| Rate for Payer: Aetna Commercial |
$195.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$149.70
|
| Rate for Payer: Cash Price |
$184.24
|
| Rate for Payer: Cofinity Commercial |
$161.21
|
| Rate for Payer: Cofinity Commercial |
$198.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$161.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.24
|
| Rate for Payer: Healthscope Commercial |
$207.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$161.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$172.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195.76
|
| Rate for Payer: PHP Commercial |
$195.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.70
|
| Rate for Payer: Priority Health SBD |
$145.09
|
| Rate for Payer: UMR Bronson Commercial |
$101.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$172.72
|
|
|
POLYSACCHARIDE IRON COMPLEX 150 MG IRON CAPSULE
|
Facility
|
IP
|
$4.19
|
|
|
Service Code
|
NDC 51991020399
|
| Hospital Charge Code |
11050
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.84 |
| Max. Negotiated Rate |
$3.77 |
| Rate for Payer: Aetna American Axle |
$2.72
|
| Rate for Payer: Aetna Commercial |
$3.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.72
|
| Rate for Payer: Cash Price |
$3.35
|
| Rate for Payer: Cofinity Commercial |
$2.93
|
| Rate for Payer: Cofinity Commercial |
$3.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.35
|
| Rate for Payer: Healthscope Commercial |
$3.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.56
|
| Rate for Payer: PHP Commercial |
$3.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.72
|
| Rate for Payer: Priority Health SBD |
$2.64
|
| Rate for Payer: UMR Bronson Commercial |
$1.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.14
|
|
|
POLYSACCHARIDE IRON COMPLEX 150 MG IRON CAPSULE
|
Facility
|
OP
|
$4.19
|
|
|
Service Code
|
NDC 51991020399
|
| Hospital Charge Code |
11050
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.55 |
| Max. Negotiated Rate |
$3.77 |
| Rate for Payer: Aetna American Axle |
$2.72
|
| Rate for Payer: Aetna Commercial |
$3.56
|
| Rate for Payer: Aetna Medicare |
$2.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.72
|
| Rate for Payer: BCBS Complete |
$1.68
|
| Rate for Payer: Cash Price |
$3.35
|
| Rate for Payer: Cofinity Commercial |
$2.93
|
| Rate for Payer: Cofinity Commercial |
$3.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.35
|
| Rate for Payer: Healthscope Commercial |
$3.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.56
|
| Rate for Payer: PHP Commercial |
$3.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.72
|
| Rate for Payer: Priority Health SBD |
$2.64
|
| Rate for Payer: UMR Bronson Commercial |
$1.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.14
|
|
|
POLYSACCHARIDE IRON COMPLEX 150 MG IRON CAPSULE
|
Facility
|
IP
|
$418.30
|
|
|
Service Code
|
NDC 51991020311
|
| Hospital Charge Code |
11050
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$184.05 |
| Max. Negotiated Rate |
$376.47 |
| Rate for Payer: Aetna American Axle |
$271.90
|
| Rate for Payer: Aetna Commercial |
$355.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$271.90
|
| Rate for Payer: Cash Price |
$334.64
|
| Rate for Payer: Cofinity Commercial |
$292.81
|
| Rate for Payer: Cofinity Commercial |
$359.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$292.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$334.64
|
| Rate for Payer: Healthscope Commercial |
$376.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$292.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$313.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$355.56
|
| Rate for Payer: PHP Commercial |
$355.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$271.90
|
| Rate for Payer: Priority Health SBD |
$263.53
|
| Rate for Payer: UMR Bronson Commercial |
$184.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$313.72
|
|
|
POLYSORBATE 80 SOLUTION
|
Facility
|
OP
|
$399.50
|
|
|
Service Code
|
NDC 38779052608
|
| Hospital Charge Code |
6395
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.82 |
| Max. Negotiated Rate |
$359.55 |
| Rate for Payer: Aetna American Axle |
$259.68
|
| Rate for Payer: Aetna Commercial |
$339.58
|
| Rate for Payer: Aetna Medicare |
$199.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$259.68
|
| Rate for Payer: BCBS Complete |
$159.80
|
| Rate for Payer: Cash Price |
$319.60
|
| Rate for Payer: Cofinity Commercial |
$279.65
|
| Rate for Payer: Cofinity Commercial |
$343.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$279.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$319.60
|
| Rate for Payer: Healthscope Commercial |
$359.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$279.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$299.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$339.58
|
| Rate for Payer: PHP Commercial |
$339.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$259.68
|
| Rate for Payer: Priority Health SBD |
$251.68
|
| Rate for Payer: UMR Bronson Commercial |
$147.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$299.62
|
|
|
POLYSORBATE 80 SOLUTION
|
Facility
|
IP
|
$399.50
|
|
|
Service Code
|
NDC 38779052608
|
| Hospital Charge Code |
6395
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$175.78 |
| Max. Negotiated Rate |
$359.55 |
| Rate for Payer: Aetna American Axle |
$259.68
|
| Rate for Payer: Aetna Commercial |
$339.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$259.68
|
| Rate for Payer: Cash Price |
$319.60
|
| Rate for Payer: Cofinity Commercial |
$279.65
|
| Rate for Payer: Cofinity Commercial |
$343.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$279.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$319.60
|
| Rate for Payer: Healthscope Commercial |
$359.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$279.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$299.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$339.58
|
| Rate for Payer: PHP Commercial |
$339.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$259.68
|
| Rate for Payer: Priority Health SBD |
$251.68
|
| Rate for Payer: UMR Bronson Commercial |
$175.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$299.62
|
|
|
POLYVINYL ALCOHOL-POVIDONE (PF) 1.4 %-0.6 % EYE DROPS IN A DROPPERETTE
|
Facility
|
IP
|
$3.12
|
|
|
Service Code
|
NDC 00023050650
|
| Hospital Charge Code |
112480
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$2.81 |
| Rate for Payer: Aetna American Axle |
$2.03
|
| Rate for Payer: Aetna Commercial |
$2.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.03
|
| Rate for Payer: Cash Price |
$2.50
|
| Rate for Payer: Cofinity Commercial |
$2.18
|
| Rate for Payer: Cofinity Commercial |
$2.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.50
|
| Rate for Payer: Healthscope Commercial |
$2.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.65
|
| Rate for Payer: PHP Commercial |
$2.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.03
|
| Rate for Payer: Priority Health SBD |
$1.97
|
| Rate for Payer: UMR Bronson Commercial |
$1.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.34
|
|
|
POLYVINYL ALCOHOL-POVIDONE (PF) 1.4 %-0.6 % EYE DROPS IN A DROPPERETTE
|
Facility
|
OP
|
$3.12
|
|
|
Service Code
|
NDC 00023050650
|
| Hospital Charge Code |
112480
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$2.81 |
| Rate for Payer: Aetna American Axle |
$2.03
|
| Rate for Payer: Aetna Commercial |
$2.65
|
| Rate for Payer: Aetna Medicare |
$1.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.03
|
| Rate for Payer: BCBS Complete |
$1.25
|
| Rate for Payer: Cash Price |
$2.50
|
| Rate for Payer: Cofinity Commercial |
$2.18
|
| Rate for Payer: Cofinity Commercial |
$2.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.50
|
| Rate for Payer: Healthscope Commercial |
$2.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.65
|
| Rate for Payer: PHP Commercial |
$2.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.03
|
| Rate for Payer: Priority Health SBD |
$1.97
|
| Rate for Payer: UMR Bronson Commercial |
$1.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.34
|
|
|
PORACTANT ALFA 120 MG/1.5 ML INTRATRACHEAL SUSPENSION
|
Facility
|
OP
|
$1,921.90
|
|
|
Service Code
|
NDC 10122051001
|
| Hospital Charge Code |
27047
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$711.10 |
| Max. Negotiated Rate |
$1,729.71 |
| Rate for Payer: Aetna American Axle |
$1,249.24
|
| Rate for Payer: Aetna Commercial |
$1,633.62
|
| Rate for Payer: Aetna Medicare |
$960.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,249.24
|
| Rate for Payer: BCBS Complete |
$768.76
|
| Rate for Payer: Cash Price |
$1,537.52
|
| Rate for Payer: Cofinity Commercial |
$1,345.33
|
| Rate for Payer: Cofinity Commercial |
$1,652.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,345.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,537.52
|
| Rate for Payer: Healthscope Commercial |
$1,729.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,345.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,441.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,633.62
|
| Rate for Payer: PHP Commercial |
$1,633.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,249.24
|
| Rate for Payer: Priority Health SBD |
$1,210.80
|
| Rate for Payer: UMR Bronson Commercial |
$711.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,441.42
|
|
|
PORACTANT ALFA 120 MG/1.5 ML INTRATRACHEAL SUSPENSION
|
Facility
|
IP
|
$1,921.90
|
|
|
Service Code
|
NDC 10122051001
|
| Hospital Charge Code |
27047
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$845.64 |
| Max. Negotiated Rate |
$1,729.71 |
| Rate for Payer: Cash Price |
$1,537.52
|
| Rate for Payer: Cofinity Commercial |
$1,345.33
|
| Rate for Payer: Cofinity Commercial |
$1,652.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,345.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,537.52
|
| Rate for Payer: Healthscope Commercial |
$1,729.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,345.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,441.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,633.62
|
| Rate for Payer: PHP Commercial |
$1,633.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,249.24
|
| Rate for Payer: Priority Health SBD |
$1,210.80
|
| Rate for Payer: UMR Bronson Commercial |
$845.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,441.42
|
| Rate for Payer: Aetna American Axle |
$1,249.24
|
| Rate for Payer: Aetna Commercial |
$1,633.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,249.24
|
|
|
POSACONAZOLE 100 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$4,100.79
|
|
|
Service Code
|
NDC 60687052321
|
| Hospital Charge Code |
169019
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,517.29 |
| Max. Negotiated Rate |
$3,690.71 |
| Rate for Payer: Aetna American Axle |
$2,665.51
|
| Rate for Payer: Aetna Commercial |
$3,485.67
|
| Rate for Payer: Aetna Medicare |
$2,050.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,665.51
|
| Rate for Payer: BCBS Complete |
$1,640.32
|
| Rate for Payer: Cash Price |
$3,280.63
|
| Rate for Payer: Cofinity Commercial |
$2,870.55
|
| Rate for Payer: Cofinity Commercial |
$3,526.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,870.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,280.63
|
| Rate for Payer: Healthscope Commercial |
$3,690.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,870.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,075.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,485.67
|
| Rate for Payer: PHP Commercial |
$3,485.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,665.51
|
| Rate for Payer: Priority Health SBD |
$2,583.50
|
| Rate for Payer: UMR Bronson Commercial |
$1,517.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,075.59
|
|
|
POSACONAZOLE 100 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$136.70
|
|
|
Service Code
|
NDC 60687052311
|
| Hospital Charge Code |
169019
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.58 |
| Max. Negotiated Rate |
$123.03 |
| Rate for Payer: Aetna American Axle |
$88.86
|
| Rate for Payer: Aetna Commercial |
$116.20
|
| Rate for Payer: Aetna Medicare |
$68.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.86
|
| Rate for Payer: BCBS Complete |
$54.68
|
| Rate for Payer: Cash Price |
$109.36
|
| Rate for Payer: Cofinity Commercial |
$117.56
|
| Rate for Payer: Cofinity Commercial |
$95.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$95.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.36
|
| Rate for Payer: Healthscope Commercial |
$123.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$95.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.20
|
| Rate for Payer: PHP Commercial |
$116.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.86
|
| Rate for Payer: Priority Health SBD |
$86.12
|
| Rate for Payer: UMR Bronson Commercial |
$50.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.52
|
|
|
POSACONAZOLE 100 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$3,337.77
|
|
|
Service Code
|
NDC 00254204502
|
| Hospital Charge Code |
169019
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,468.62 |
| Max. Negotiated Rate |
$3,003.99 |
| Rate for Payer: Aetna American Axle |
$2,169.55
|
| Rate for Payer: Aetna Commercial |
$2,837.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,169.55
|
| Rate for Payer: Cash Price |
$2,670.22
|
| Rate for Payer: Cofinity Commercial |
$2,336.44
|
| Rate for Payer: Cofinity Commercial |
$2,870.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,336.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,670.22
|
| Rate for Payer: Healthscope Commercial |
$3,003.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,336.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,503.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,837.10
|
| Rate for Payer: PHP Commercial |
$2,837.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,169.55
|
| Rate for Payer: Priority Health SBD |
$2,102.80
|
| Rate for Payer: UMR Bronson Commercial |
$1,468.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,503.33
|
|
|
POSACONAZOLE 100 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$4,100.79
|
|
|
Service Code
|
NDC 60687052321
|
| Hospital Charge Code |
169019
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,804.35 |
| Max. Negotiated Rate |
$3,690.71 |
| Rate for Payer: Aetna American Axle |
$2,665.51
|
| Rate for Payer: Aetna Commercial |
$3,485.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,665.51
|
| Rate for Payer: Cash Price |
$3,280.63
|
| Rate for Payer: Cofinity Commercial |
$2,870.55
|
| Rate for Payer: Cofinity Commercial |
$3,526.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,870.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,280.63
|
| Rate for Payer: Healthscope Commercial |
$3,690.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,870.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,075.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,485.67
|
| Rate for Payer: PHP Commercial |
$3,485.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,665.51
|
| Rate for Payer: Priority Health SBD |
$2,583.50
|
| Rate for Payer: UMR Bronson Commercial |
$1,804.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,075.59
|
|
|
POSACONAZOLE 100 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$136.70
|
|
|
Service Code
|
NDC 60687052311
|
| Hospital Charge Code |
169019
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.15 |
| Max. Negotiated Rate |
$123.03 |
| Rate for Payer: Aetna American Axle |
$88.86
|
| Rate for Payer: Aetna Commercial |
$116.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.86
|
| Rate for Payer: Cash Price |
$109.36
|
| Rate for Payer: Cofinity Commercial |
$117.56
|
| Rate for Payer: Cofinity Commercial |
$95.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$95.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.36
|
| Rate for Payer: Healthscope Commercial |
$123.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$95.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.20
|
| Rate for Payer: PHP Commercial |
$116.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.86
|
| Rate for Payer: Priority Health SBD |
$86.12
|
| Rate for Payer: UMR Bronson Commercial |
$60.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.52
|
|
|
POSACONAZOLE 100 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$1,530.25
|
|
|
Service Code
|
NDC 70748025807
|
| Hospital Charge Code |
169019
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$673.31 |
| Max. Negotiated Rate |
$1,377.22 |
| Rate for Payer: Aetna American Axle |
$994.66
|
| Rate for Payer: Aetna Commercial |
$1,300.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$994.66
|
| Rate for Payer: Cash Price |
$1,224.20
|
| Rate for Payer: Cofinity Commercial |
$1,071.18
|
| Rate for Payer: Cofinity Commercial |
$1,316.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,071.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,224.20
|
| Rate for Payer: Healthscope Commercial |
$1,377.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,071.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,147.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,300.71
|
| Rate for Payer: PHP Commercial |
$1,300.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$994.66
|
| Rate for Payer: Priority Health SBD |
$964.06
|
| Rate for Payer: UMR Bronson Commercial |
$673.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,147.69
|
|
|
POSACONAZOLE 100 MG TABLET,DELAYED RELEASE
|
Facility
|
IP
|
$14,148.73
|
|
|
Service Code
|
NDC 00085432402
|
| Hospital Charge Code |
169019
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6,225.44 |
| Max. Negotiated Rate |
$12,733.86 |
| Rate for Payer: Aetna American Axle |
$9,196.67
|
| Rate for Payer: Aetna Commercial |
$12,026.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,196.67
|
| Rate for Payer: Cash Price |
$11,318.98
|
| Rate for Payer: Cofinity Commercial |
$12,167.91
|
| Rate for Payer: Cofinity Commercial |
$9,904.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$9,904.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,318.98
|
| Rate for Payer: Healthscope Commercial |
$12,733.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9,904.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,611.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,026.42
|
| Rate for Payer: PHP Commercial |
$12,026.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,196.67
|
| Rate for Payer: Priority Health SBD |
$8,913.70
|
| Rate for Payer: UMR Bronson Commercial |
$6,225.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,611.55
|
|
|
POSACONAZOLE 100 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$14,148.73
|
|
|
Service Code
|
NDC 00085432402
|
| Hospital Charge Code |
169019
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5,235.03 |
| Max. Negotiated Rate |
$12,733.86 |
| Rate for Payer: Aetna American Axle |
$9,196.67
|
| Rate for Payer: Aetna Commercial |
$12,026.42
|
| Rate for Payer: Aetna Medicare |
$7,074.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,196.67
|
| Rate for Payer: BCBS Complete |
$5,659.49
|
| Rate for Payer: Cash Price |
$11,318.98
|
| Rate for Payer: Cofinity Commercial |
$12,167.91
|
| Rate for Payer: Cofinity Commercial |
$9,904.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$9,904.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,318.98
|
| Rate for Payer: Healthscope Commercial |
$12,733.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9,904.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,611.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,026.42
|
| Rate for Payer: PHP Commercial |
$12,026.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,196.67
|
| Rate for Payer: Priority Health SBD |
$8,913.70
|
| Rate for Payer: UMR Bronson Commercial |
$5,235.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,611.55
|
|
|
POSACONAZOLE 100 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$1,530.25
|
|
|
Service Code
|
NDC 70748025807
|
| Hospital Charge Code |
169019
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$566.19 |
| Max. Negotiated Rate |
$1,377.22 |
| Rate for Payer: Aetna American Axle |
$994.66
|
| Rate for Payer: Aetna Commercial |
$1,300.71
|
| Rate for Payer: Aetna Medicare |
$765.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$994.66
|
| Rate for Payer: BCBS Complete |
$612.10
|
| Rate for Payer: Cash Price |
$1,224.20
|
| Rate for Payer: Cofinity Commercial |
$1,071.18
|
| Rate for Payer: Cofinity Commercial |
$1,316.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,071.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,224.20
|
| Rate for Payer: Healthscope Commercial |
$1,377.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,071.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,147.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,300.71
|
| Rate for Payer: PHP Commercial |
$1,300.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$994.66
|
| Rate for Payer: Priority Health SBD |
$964.06
|
| Rate for Payer: UMR Bronson Commercial |
$566.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,147.69
|
|
|
POSACONAZOLE 100 MG TABLET,DELAYED RELEASE
|
Facility
|
OP
|
$3,337.77
|
|
|
Service Code
|
NDC 00254204502
|
| Hospital Charge Code |
169019
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,234.97 |
| Max. Negotiated Rate |
$3,003.99 |
| Rate for Payer: Aetna American Axle |
$2,169.55
|
| Rate for Payer: Aetna Commercial |
$2,837.10
|
| Rate for Payer: Aetna Medicare |
$1,668.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,169.55
|
| Rate for Payer: BCBS Complete |
$1,335.11
|
| Rate for Payer: Cash Price |
$2,670.22
|
| Rate for Payer: Cofinity Commercial |
$2,336.44
|
| Rate for Payer: Cofinity Commercial |
$2,870.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,336.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,670.22
|
| Rate for Payer: Healthscope Commercial |
$3,003.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,336.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,503.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,837.10
|
| Rate for Payer: PHP Commercial |
$2,837.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,169.55
|
| Rate for Payer: Priority Health SBD |
$2,102.80
|
| Rate for Payer: UMR Bronson Commercial |
$1,234.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,503.33
|
|
|
POSACONAZOLE 200 MG/5 ML (40 MG/ML) ORAL SUSPENSION
|
Facility
|
IP
|
$4,953.38
|
|
|
Service Code
|
NDC 00085132801
|
| Hospital Charge Code |
77371
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,179.49 |
| Max. Negotiated Rate |
$4,458.04 |
| Rate for Payer: Aetna American Axle |
$3,219.70
|
| Rate for Payer: Aetna Commercial |
$4,210.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,219.70
|
| Rate for Payer: Cash Price |
$3,962.70
|
| Rate for Payer: Cofinity Commercial |
$3,467.37
|
| Rate for Payer: Cofinity Commercial |
$4,259.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,467.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,962.70
|
| Rate for Payer: Healthscope Commercial |
$4,458.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,467.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,715.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,210.37
|
| Rate for Payer: PHP Commercial |
$4,210.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,219.70
|
| Rate for Payer: Priority Health SBD |
$3,120.63
|
| Rate for Payer: UMR Bronson Commercial |
$2,179.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,715.04
|
|
|
POSACONAZOLE 200 MG/5 ML (40 MG/ML) ORAL SUSPENSION
|
Facility
|
IP
|
$2,714.07
|
|
|
Service Code
|
NDC 00254101636
|
| Hospital Charge Code |
77371
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,194.19 |
| Max. Negotiated Rate |
$2,442.66 |
| Rate for Payer: Aetna American Axle |
$1,764.15
|
| Rate for Payer: Aetna Commercial |
$2,306.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,764.15
|
| Rate for Payer: Cash Price |
$2,171.26
|
| Rate for Payer: Cofinity Commercial |
$1,899.85
|
| Rate for Payer: Cofinity Commercial |
$2,334.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,899.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,171.26
|
| Rate for Payer: Healthscope Commercial |
$2,442.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,899.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,035.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,306.96
|
| Rate for Payer: PHP Commercial |
$2,306.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,764.15
|
| Rate for Payer: Priority Health SBD |
$1,709.86
|
| Rate for Payer: UMR Bronson Commercial |
$1,194.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,035.55
|
|
|
POSACONAZOLE 200 MG/5 ML (40 MG/ML) ORAL SUSPENSION
|
Facility
|
OP
|
$4,953.38
|
|
|
Service Code
|
NDC 00085132801
|
| Hospital Charge Code |
77371
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,832.75 |
| Max. Negotiated Rate |
$4,458.04 |
| Rate for Payer: Aetna American Axle |
$3,219.70
|
| Rate for Payer: Aetna Commercial |
$4,210.37
|
| Rate for Payer: Aetna Medicare |
$2,476.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,219.70
|
| Rate for Payer: BCBS Complete |
$1,981.35
|
| Rate for Payer: Cash Price |
$3,962.70
|
| Rate for Payer: Cofinity Commercial |
$3,467.37
|
| Rate for Payer: Cofinity Commercial |
$4,259.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,467.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,962.70
|
| Rate for Payer: Healthscope Commercial |
$4,458.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,467.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,715.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,210.37
|
| Rate for Payer: PHP Commercial |
$4,210.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,219.70
|
| Rate for Payer: Priority Health SBD |
$3,120.63
|
| Rate for Payer: UMR Bronson Commercial |
$1,832.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,715.04
|
|
|
POSACONAZOLE 200 MG/5 ML (40 MG/ML) ORAL SUSPENSION
|
Facility
|
OP
|
$2,714.07
|
|
|
Service Code
|
NDC 00254101636
|
| Hospital Charge Code |
77371
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,004.21 |
| Max. Negotiated Rate |
$2,442.66 |
| Rate for Payer: Aetna American Axle |
$1,764.15
|
| Rate for Payer: Aetna Commercial |
$2,306.96
|
| Rate for Payer: Aetna Medicare |
$1,357.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,764.15
|
| Rate for Payer: BCBS Complete |
$1,085.63
|
| Rate for Payer: Cash Price |
$2,171.26
|
| Rate for Payer: Cofinity Commercial |
$1,899.85
|
| Rate for Payer: Cofinity Commercial |
$2,334.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,899.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,171.26
|
| Rate for Payer: Healthscope Commercial |
$2,442.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,899.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,035.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,306.96
|
| Rate for Payer: PHP Commercial |
$2,306.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,764.15
|
| Rate for Payer: Priority Health SBD |
$1,709.86
|
| Rate for Payer: UMR Bronson Commercial |
$1,004.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,035.55
|
|
